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Organization
CHERRY HILL CLINIC, LLC
Active
Organization
CHERRY HILL CLINIC, LLC
Active
Other names
Cherry Hill Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN DUKATE (CREDENTIALING SPECIALIST)
(904) 515-2625
Entity
Organization
Contact information
Practice address
1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335
(352) 226-7603
Mailing address
1160 E HIGH POINT LN, COLUMBIA, MO 65203-9335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011003501
MD LICENSE
MO
Enumeration date
09/20/2017
Last updated
09/20/2017
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